Method and apparatus for identifying patients overdue for an appointment using standard healthcare billing data

ABSTRACT

A method and apparatus for identifying overdue patients using standard billing or other office management data, so that patients can be contacted and invited to make an appointment. The invention begins by querying the diagnosis codes for each visit from the billing or other encounter tables, and matching these with a set of target medical conditions requiring regular care. Procedure codes and encounter dates for past visits are queried for these patients, to determine when each patient was last seen, and what was done. These procedure codes are matched against a set of exam codes to determine last medical examination dates, and against a set of procedures known to resolve each medical condition. Each condition requiring regular care is matched against any resolving procedures, leaving a set of untreated conditions requiring regular care. Based on the date of the last exam or treatment and accepted standards of care or office policies, a due date is calculated for each patient. The management system is queried for each overdue patient to determine whether they already have an appointment scheduled in the future, or a recall notice recently sent or yet to be sent. Additional filtering based on administrative settings may also be done. Overdue patients requiring contact are then placed on the contact list.

This application is a Continuation application of U.S. patentapplication Ser. No. 11/938,087, filed Nov. 9, 2007. U.S. applicationSer. No. 11/938,087 claims priority from U.S. patent application Ser.No. 11/484,340, filed July 10, 2006, and U.S. patent application Ser.No. 11/934,615, filed Nov. 2, 2007, all of which are hereby incorporatedby reference.

TECHNICAL FIELD OF THE INVENTION

The present invention relates to a method and apparatus for internalmarketing, and more particularly, to a method and apparatus foridentifying patients who are due for a health care appointment andfacilitating contact with those patients.

BACKGROUND AND SUMMARY OF THE INVENTION

Most healthcare practices rely on scheduled appointments to provide anagreed time and place to serve patients. In many cases, after serving apatient, a return appointment will be recommended for some time in thefuture. Often, an appointment is made for a return visit before thepatient leaves the office. However, if the needed appointment is too farout, if staff schedules are unreliable, or if a suitable appointmentcannot be found quickly, then the office may instead choose to use arecall. A recall is a notice, sent to the patient prior to the desiredappointment date, reminding the patient to call to schedule anappointment.

Contacting patients who are overdue for health care services is acost-effective way of both improving care and increasing revenue byfilling available appointments. However, existing methods of identifyingoverdue patients use unreliable means of identifying patients who areoverdue for care. Consequently, the call list is often both incompleteand inaccurate.

Many management systems that schedule patient appointments providesupport for recall notices. Typically, these systems allow entry of atarget date for the unscheduled appointment, which is associated withthe patient, and some notes about the reason for the recall. On aregular basis, the management system is used to generate printed cards,letters or address labels, so that reminders to call for an appointmentcan be sent to the appropriate patients. Instead of printed reminders,automated calling systems are sometimes used to leave a recorded messagerequesting a return call to schedule an appointment.

These systems often provide a list of patients who have not responded torecall notices, so that these patients can be contacted or remindedagain. Unfortunately, a simple list of unresponsive patients isinadequate for multiple schedulers involved in a shared, sustainedeffort to contact patients and schedule these appointments. Schedulersrequire a record of the times and dates of messages left so thatadditional messages are not left with the same patients until asufficient time has elapsed as to warrant another contact. Further,schedulers require that as patients are contacted successfully andappointments are scheduled, that these patients are deleted from thelist so that these are not contacted again after an appointment is made.

Thus, the health care industry needs a system for generating completeand reliable call lists using only data that is readily available inmost offices.

SUMMARY OF THE INVENTION

An object of the present invention is to use health care data from adatabase to identify patients who require appointments for health careand to facilitate contacting such patients to schedule appointments.

The present invention improves internal marketing by recapturing lostbusiness by identifying and facilitating the contacting of patients whohave not scheduled an appointment.

In a typical embodiment, a system uses information about a healthcondition, for example, from medical or dental billing data in apractice management system, to determine when a patient appointment isrequired. The system then facilitates contact with the patient toschedule the appointment.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a flow chart showing a preferred method in accordance with theinvention.

FIG. 2 is a diagram of portions of tables relevant to the presentinvention, in the management system and in the patient reactivationsystem described in this invention.

FIG. 3 is an exemplary table of Transact-SQL search strings that willmatch standard diagnosis codes used to identify conditions requiringregular care, and resolution of these conditions. This table alsoindicates the normal visit interval for each condition.

FIG. 4 is an exemplary table of standard procedure codes indicatingophthalmology exams. When matched with specific encounters in thebilling tables, these indicate the dates of past examinations.

FIG. 5 shows a display screen used to provide into to and collectinformation from a caller.

FIG. 6 shows schematically the hardware implementing the presentinvention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

One aspect of some embodiments of the invention is the identification ofpatients who are overdue for care without having to rely on recall data,appointment types or notes, or electronic medical records.

Another aspect of some embodiments of the invention is theidentification of patients' health conditions more specifically, so thatrequired visit intervals can be determined more accurately when norecall data exists.

Another aspect of some embodiments of the invention is the recognitionof patients who have been cured of specific medical or dentalconditions, so that their required visit intervals can be appropriatelyupdated or eliminated.

Some embodiments of the present invention overcome the limitations ofthe prior art by using standard diagnosis and procedure codes availablein billing or other encounter tables to identify patients with specificconditions, in order to accurately identify patients who are overdue forcare. In addition, using these codes enables the current system toidentify conditions which have been resolved and no longer requireregular care. The benefits are a far more complete and accurate list ofpatients requiring contact. The codes, such as billing codes andprocedural codes are typically available in a one or more practicedatabases used in a typical health care practice. The schedulingsoftware, billing software, and associated databases are referred to asa “practice management system.” Software of the present invention can beused together with an existing practice management system, or can beintegrated into a practice management system. The term “electronicmedical records” typically connotes a different type of software frompractice management software, although the two may be integrated.Electronic medical records typically replace the patients' medicalcharts and include the patient's subjective complaint, the objectiveexamination results, the clinician's assessment and a care plan.Embodiments of the invention do not require electronic medical records,which are not as ubiquitous as practice management software.

FIG. 1 shows the steps of a preferred embodiment. In step 102, thesystem queries the diagnosis codes for past patient visits from thebilling or other encounter tables in the practice management system. Instep 104, the system matches these codes with a set of target conditionsrequiring regular care and, if a patient's diagnostic code indicatesthat he requires regular care, the patient's identification, along withthe corresponding diagnosis, is stored as patient-diagnosis pairs in apatient reactivation system.

Next, in step 110, the procedure codes and encounter dates for pastvisits are queried for the patients stored in the patient reactivationsystem to determine when each patient was last seen, and what was done.In step 114, these procedure codes are matched against a set of examcodes to determine the dates of the last examination. In step 116, theprocedure codes are matched against a set of procedures known to resolveeach medical condition.

In decision block 120, each condition requiring regular care is matchedagainst any resolving procedures and in step 122, cases in which thediagnosis has been resolved are eliminated from the list, leaving a setof untreated conditions requiring regular care. Based on the date of thelast exam or treatment and accepted standards of care or officepolicies, a due date is calculated for each patient as part of decisionblock step 124. Patients that are not overdue for making an appointmentin accordance with predetermined standards are eliminated from the listin step 126.

In step 128, the system checks each patient on the list to determinewhether they already have an appointment scheduled or a pending recallnotice yet to be sent, and if so, those patients are removed from thefollow-up list in step 130. Patients may also be removed from the listfor other, miscellaneous administrative reasons, as described below.Overdue patients without an appointment or pending recall notice form acontact list in step 134 and are contacted, either by a person or by anautomatic messaging machine, in step 136.

In summary, the steps of a preferred method can be broadly described as:Query the management system for a list of all patients who havediagnoses requiring regular treatment, and store these aspatient-diagnosis pairs in the patient reactivation system. Eliminatepatient-diagnosis pairs where the diagnosis has been resolved. Determinethe date of the most recent treatment for unresolved diagnoses. Identifypatients who are overdue for care. Eliminate from the list patients whoalready have appointments. Eliminate from the list patients who recentlyreceived or who will receive reminders to call for an appointment.Eliminate from the list patients excluded as per administrativesettings. These steps are described in more detail below. The stepsdescribed above are preferably performed automatically under computercontrol. That is, the steps are performed by the computer in accordancewith programmed instructions and without human intervention. Automaticoperation does not exclude a person initiating any step or the entireprocess.

Query the Management System for a List of All Patients Who haveDiagnoses Requiring Regular Treatment, and Store these asPatient-Diagnoses Pairs.

The diagnosis code table 202 (FIG. 2) is part of the preferred patientreactivation system 200, and provides a list of diagnoses which requireregular care. This table is interpreted as follows (see FIG. 3). Codesin rows where is_resolve=0 indicate the diagnosis of the given medicalcondition. Codes in rows where is_resolve=1 indicate resolution (cure)of the given condition. When is_icd9=1, it indicates the code is adiagnosis code (for example, an ICD9-CM code). When is_icd9=0, itindicates the code is a procedure code (for example, a CPT-4 code). Thecodes in this table are Transact-SQL search strings. Visit_intervalgives the number of months between visits, according to acceptedstandards of care or office policies. Description provides ahuman-readable description of each medical condition.

If a management system has been used by the practice to bill Medicare orother insurance companies, then standard diagnosis codes and procedurecodes will be recorded in tables associated with these patient charges,along with the dates of encounters, rendering providers and locations.There are many different management systems, each with its own databaseschema, so the exact query will vary from system to system. However,most of these systems are built on standard database products, such asMicrosoft SQL Server, which can be queried using standard, documentedquery language.

Query the management system 206 for charges 207 whose diagnosis codesmatch the Transact-SQL search strings in the diagnosis code table 202where is_resolve=0, and store into the patient_diagnosis table 201 thepatient_id, diag_id, date_of service, provider and location for eachmatching charge. When there are duplicate diagnoses for the samepatient, store only the most recent. For example, if a patient isdiagnosed in Mar. 6, 2007 for glaucoma, and returns in Aug. 11, 2007 andis again diagnosed with glaucoma, and in addition is diagnosed withcataracts, store one glaucoma diagnosis for this patient with a date ofAug. 11, 2007, and a cataract diagnosis for this patient with the samedate. Do not store the Mar. 6, 2007 glaucoma diagnosis.

Eliminate Patient-Diagnosis Pairs Where the Diagnosis has been Resolved.

Query the management system 206 for charges 207 whose diagnosis orprocedure codes match the Transact-SQL search strings in the diagnosiscode table 202 where is_resolve=1 (FIG. 3). Delete from thepatient_diagnosis table (201) any rows with a matching diag_id, wherethe date of diagnosis is earlier than or equal to the date ofresolution.

Determine the Date of the Most Recent Treatment for UnresolvedConditions.

This step differentiates between visits that are related to theunresolved diagnosis and visits for other purposes that should notaffect the due date. Regularly scheduled exams are often used to followmedical conditions which must be monitored closely. Other procedures mayalso provide regular treatment. If the management system is used to billMedicare or commercial insurance companies, then any medical servicesprovided will be identified with the charges using standard procedurecodes, such as CPT-4 codes. The date of service, rendering provider,location and patient id will also be recorded in these tables.

FIG. 4 shows an exemplary table of exam codes for ophthalmology. Theprocedures represented by these codes are used to treat the conditionslisted in FIG. 3, but do not cure these conditions.

To determine the date of the most recent treatment for unresolvedconditions, query the management system's billing or encounter tablesfor charges 207 whose procedure codes match any of the codes in thetable of exam codes 204. For each patient, store the most recent date ofa matching encounter as the last_exam date in the patient table 203.

Identify Patients Who are Overdue for Care.

Join the patient_diagnosis table 201 to the diagnosis_code table 202 onthe diag_id field and to the patient table 203 on the patient_id field.For each row in the resulting table, calculate the time since the lastexamination and compare it to the visit interval for the givendiagnosis. If the time since last examination exceeds the visitinterval, then the patient is overdue. Store the list of patient_id'sfor patients who are overdue into the next_contacts table 205.

Eliminate from the List Patients Who Already Have Appointments

Query the management system 206 for appointments 208 in the future foreach patient in the next contacts list. Delete any patients from thenext_contacts table 205 who have future appointments scheduled.

Eliminate from the List Patients Who Recently Received or Who WillReceive Reminders to Call for an Appointment.

Query the management system 206 for recalls 209 which will be sent inthe future, or which have been sent recently (for example, within sixweeks), and delete any patients from the next_contacts table 205 whohave just been sent or who will receive recall notices.

Eliminate from the List Patients Excluded as per AdministrativeSettings.

Various other administrative settings may indicate patients who shouldnot be contacted, such as patients having specific insurance, patientswithin a given age range, patients who have not been seen for a verylong time, patients seen by specific doctors or at specific locations,patients who have been discharged or are in collections, deceasedpatients, and so on. These checks are made using additional queries, andmatching patients are deleted from the next_contacts table 205.

Telephone the Patient

In step 138, information about the patient is displayed for a humancaller to telephone the patient. FIG. 5 shows a typical display screen.The information preferably includes the patient's name, telephonenumber, and the reason that an appointment should be made. The callerreviews the information and telephones the patient. The actual dialingmay be performed by an automatic dialing system. Alternatively, anautomatic messaging system can call the patient and leave a message.

Enter Call Result Information

The caller enters the call results into the lower portion of the screenshown in FIG. 5. The caller may also schedule an appointment for thepatient while the patient is on the telephone. In some embodiments, thecaller may transfer the patient to a scheduler to schedule theappointment. The caller preferably works in the same office that willprovide care for the patient to facilitate scheduling and to increasethe likelihood that the caller is personally known to the patient.

FIG. 5 shows several possible call results, including “busy,” “noanswer,” “voice mail,” and “disconnected,” that the caller may enter. Ifthe patient answered the call, the caller follows the link “answered,”which leads to other choices (not shown), such as “appointment made,”“condition resolved,” “call back at specified time,” “call a differentnumber,” that the caller may select. The system can then determine fromthe entered call results whether or not a subsequent call is requiredand can determine the optimum time for any subsequent call back. Thesystem may determine from the entry that no call back is required, andthe patient can be removed from the contact list. If an automaticcalling system was used, the call result information may be limited to“no answer”, “busy” and “left message.”

While an automated dialing machine can be used to dial the patient'snumber, it is preferable to have a real person speak to the patient,rather than having a machine deliver a recorded or computer generatedmessage. An automated machine leaving a message provides one waycommunication; it does not provide two way communications in which thepatient can respond, ask questions, or have any interaction.

Having a real person speak to the patient provides several benefits. Theprimary purpose of contacting the patient, that is, the scheduling of anappointment, can be more readily accomplished if the patient canschedule an appointment during the call. A recorded message can onlyprompt the patient to call the office to schedule an appointment, andsome patients may not have sufficient motivation to call the officeback. Moreover, patients typically appreciate a personal contact, ratherthan an impersonal, canned message. The healthcare office staff willoften know the patient, and a patient is more likely make an appointmentwhen speaking to a person with whom he has a relationship. Unlike anautomated dialing machine, a person can answer the patient's questionand address a patient's concerns.

Some types of calls, such as LASIK scheduling, require expertise on thepart of the caller. It is undesirable to leave an impersonal,prerecorded message for a candidate for LASIK surgery. These patientswant to know that the medical staff is going to provide attentivepersonal care, and a personal telephone contact can reassure them. Suchpatients will often have additional medical concerns that will need tobe resolved, may have questions about financing, or may have otherissues to be addressed by the caller. Some patients may not be ready toschedule an appointment, but they may be ready to take a small stepforward in terms of resolving concerns, and a human can help them toadvance in this way—a canned message cannot.

A person making the call can collect information that is useful indetermining the patient's progress toward resolution. Automated systemsare unable to sensitively and accurately collect the rich resultinformation that can be collected by a human caller, such as whether apatient has died or has lost insurance, which would indicate that apatient should not be called back, and so patients and members of theirfamilies may continue to be bothered by unnecessary messages, and theoffice contact system will not be purged of futile contacts. Otherfamily members may provide this information to a human caller, but areless likely to call back to provide this information after receiving acanned message. Repeated reminder calls to a deceased patient'shousehold may be upsetting to the family. One solution to avoid creatingill will with automated system is to limit the number of messages left,but this will reduce the number of patients that are reactivated. Inaddition, automated systems will not recognize situations where apatient is deliberately refusing needed care. A human caller can reportthis information and thereby alert the practice that it may want to senda letter of non-compliance or discharge the patient, etc. in order toavoid unnecessary liability. Thus, automated systems are not well suitedto tracking patients to resolution. Automated systems tend to be used tomake a set number of calls or messages, and quit, without getting aclear answer about what has happened with that patient.

The rich information received from a human caller allows for moreappropriate spacing of calls. For example, if the person answering thephone is not the patient, a human caller can record a preferred callbacktime, a different call back number, or an indication that the patientprefers to call the office back. A human caller can also record if thepatient does not want to be called at all. With an automated callingsystem, calls may be too frequent or the system may stop calling toosoon.

Also, a call record recorded by a person provides a more credible,verifiable record of the contact in the event it ever becomes necessaryto prove that a call was made and what was said.

Thus, by displaying a screen that provides a human operator with thenumber to call to reach the patient, information about the caller, andfields in which to record the results of the call, embodiments of thepresent invention that use human callers provide advantages, not only indetermining which patients to call, but also in increasing the number ofappointments made and overall patient satisfaction with the health careorganization.

Hardware Schematic

FIG. 6 is a block diagram showing the patient reactivation system and anexisting management system which can be used together to implement theinvention. A patient reactivation system 200 includes a recall systemuser computer 606 with a user interface, including, for example, a videodisplay by which a user can view information presented by the systemabout patients to be called, and a keyboard, mouse, or other device bywhich the user can enter data into a user computer on the system. Insome embodiments, calls to patients may be automated, and made withouthuman assistance. Patient reactivation system 200 also includes apatient reactivation system database 608 that stores lists of patientsto contact and information about the patients necessary to make thecontact. Patient reactivation system database 608 may be stored on usercomputer 606 or on a network storage location. The patient reactivationsystem 200 interfaces with the existing management system 206, whichincludes a scheduling user interface 602 and a management systemdatabase 604 that typically includes billing codes. As described above,the billing codes can be used to determine when additional visits arerequired.

The scheduling user interface 602 draws patient appointments 603 fromthe management system database 604, and writes new appointments 603 intothe management system database 604. The patient reactivation system 200determines, as described above, patients who should be contacted 610 andprompts one or more users to contact these patients. The contact resultsand history 607 are stored into the patient reactivation system database608. The patient reactivation system 200 queries the patientreactivation system database 608 to avoid contacting patientsredundantly or too frequently.

While the foregoing is a detailed description of the preferredembodiment of the invention, there are many alternative embodiments ofthe invention that would occur to those skilled in the art and that arewithin the scope of the present invention. For example, while theembodiment describes generating reminders for conditions that requiresregular care, reminders can also be generated for conditions thatrequire a single follow up visit. The term “medical” is used broadlyherein to describe any health care related activity including, forexample, dental, chiropractic, naturopathic, psychiatric, andpsychological conditions or practices. The systems described herein canbe used whenever follow up appointments are necessary. Accordingly, thepresent invention is to be determined by the following claims.

We claim as follows:
 1. A computerized method for identifying patientswho are due for care so that those patients can be personally contactedby staff at a health care facility, comprising: automaticallyidentifying, using billing or other encounter data from a computerizedmedical or dental office management system, patients with conditionsrequiring regular care; automatically determining the most recent dateof treatment using billing or other encounter data from the database;automatically identifying patients who are due for care by comparingexpected visit intervals for each condition with the time since lasttreatment, and storing these in a contact list; automaticallyidentifying patients who already have appointments or who will receivereminders to call for an appointment and removing these from the contactlist; displaying patient information to an operator, the patientinformation including at least the patient's name, telephone number, andreason why the patient is due for care; contacting the patients by theoperator; and scheduling an appointment for healthcare while the patientis on the telephone; in which the billing or other encounter dataincludes data from electronic medical records.
 2. The method of claim 1in which scheduling an appointment includes transferring the call to ascheduler.
 3. The method of claim 1 further comprising displaying ascreen that the operator can use to record the results of the contact.4. The method of claim 1 further comprising removing the patient fromthe contact list.
 5. A computerized method for identifying patients whoare due for care so that those patients can be personally contact bystaff at a health care facility, comprising: automatically identifying,using billing or other encounter data from a computerized medical officemanagement system, patients with conditions requiring regular care;automatically determining the most recent date of treatment usingbilling or other encounter data from the database; automaticallyidentifying patients who are due for care by comparing expected visitintervals for each condition with the time since last treatment, andstoring these in a contact list; automatically identifying patients whoalready have appointments or who will receive reminders to call for anappointment and removing these from the contact list; displaying patientinformation to an operator, the patient information including at leastthe patient's name, telephone number, and reason why the patient is duefor care; attempting to contact the patient by the operator; displayingto the operator a computer screen having fields in which to entercontact results; and automatically determining from the contact resultswhether to schedule a follow-up telephone call; in which the billing orother encounter data includes data from electronic medical records. 6.The method of claim 5 further comprising displaying a screen that theoperator can use to record the results of the contact.
 7. The method ofclaim 5 in which contacting the patient includes receiving informationindicating that the patient is not to be contacted and furthercomprising removing the patient from the contact list.
 8. The method ofclaim 5 in which contacting the patient includes receiving informationindicating that the patient has a different telephone number and furthercomprising attempting to contact the patient using the new telephonenumber and recording the telephone number in the office database.
 9. Acomputerized method for identifying and attempting to contact patientswho are due for care, comprising: automatically identifying, usingbilling or other encounter data from a computerized medical officemanagement system, patients with conditions requiring regular care;automatically determining the most recent date of treatment usingbilling or other encounter data from the database; automaticallyidentifying patients who are due for care by comparing expected visitintervals for each condition with the time since last treatment, andstoring these in a contact list; automatically identifying patients whoalready have appointments or who will receive reminders to call for anappointment and removing these from the contact list; and automaticallytransmitting an electronic communication to a telephone numberassociated with each patient on the contact list, the electroniccommunication including an message to the patient to schedule anappointment for health care.
 10. The method according to claim 9,further comprising eliminating from the list: patients having specificinsurance, patients over a given age, patients who have not been seenfor a very long time, patients seen by specific doctors or at specificlocation, patients who have been discharged or are in collections, orpatients who are deceased.
 11. The method according to claim 9 in whichthe electronic communication is a short message service (SMS) message.12. The method according to claim 9 in which the electroniccommunication is a multimedia messaging service (MMS) message.
 13. Themethod according to claim 9, further comprising automatically generatingrecalls or mailing labels from the list to send patients writtenreminders to call for an appointment.
 14. The method according to claim9, further comprising automatically generating from the list email topatients requesting the patients to call for an appointment. 15-20.(canceled)